Provider Demographics
NPI:1386978138
Name:HALLSTROM-CONKRIGHT, EVA TERESA (LCSW)
Entity type:Individual
Prefix:MS
First Name:EVA
Middle Name:TERESA
Last Name:HALLSTROM-CONKRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CARLYLE PLACE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530
Mailing Address - Country:US
Mailing Address - Phone:914-237-6089
Mailing Address - Fax:914-237-6099
Practice Address - Street 1:1 ODELL PLZ
Practice Address - Street 2:C/O WJCS - FAMILY MATTERS PROGRAM
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1402
Practice Address - Country:US
Practice Address - Phone:914-237-6089
Practice Address - Fax:914-237-6099
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080375104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker